Meperidine contraindications

Fever, rigors, chills, malaise headaches, myalgia Nausea, emesis Neutropenia Hepatic enzyme elevation Cutaneous—alopecia, transient, mild rashlike reaction Acetaminophen (APAP). NSAID if APAP is not effective. Meperidine for severe chills and rigors. Bedtime administration. 5-HT3 antagonist, prochlorperazine, metoclopramide, fluids Weekly complete blood count reduce dose by 30-50% Liver function tests (LFTs) weekly withhold treatment until LFTs normalize restart at 30-50% dose reduction reversible on dose reduction or cessation. Interferon is contraindicated in patients with psoriasis because exacerbation of psoriasis has been noted during IFN therapy. 

Analgesics are given to reduce abdominal pain. In the past, parenteral meperidine (50 to 100 mg) every 3 to 4 hours was usually used because it causes less spasm of the sphincter of Oddi than other opioids. Meperidine is used less frequently today because it is not as effective as other opioids and is contraindicated in renal failure. Parenteral morphine is sometimes used, but it is thought to cause spasm of the sphincter of Oddi, increases in serum amylase and, rarely, pancreatitis. Hydromorphone may also be... 

Opioids and derivatives (e.g., meperidine, butorphanol, oxycodone, hydromorphone) provide effective relief of intractable migraine but should be reserved for patients with moderate to severe infrequent headaches in whom conventional therapies are contraindicated or as rescue medication after failure to respond to conventional therapies. Opioid therapy should be closely supervised. 

Like morphine, meperidine has an active metabolite, normeperidine, formed by A-demethylation of meperidine. Normeperidine is not analgesic but is a proconvulsant and a hallucinogenic agent. For this reason, meperidine use in patients with renal or fiver insufficiency is contraindicated because of the decreased clearance of the drug and its metabolite. Convulsant activity has been documented in elderly patients given meperidine and in patients using PCA who have decreased renal function. 

Contraindications are similar to those of morphine. In addition, because normeperidine accumulates in renal dysfunction and meperidine accumulates in hepatic dysfunction, meperidine is contraindicated in such patients because of convulsant effects. Similarly, the use of meperidine is contraindicated in patients who have a... 

Contraindications Concurrent use of amiodarone, astemizole, bepridil, bupropion, cisapride, clozapine, encainide, flecainide, meperidine, piroxicam, propafenone, propoxyphene, quinidine, rifabutin, or terfenadine (increased risk of serious or life-... 

The use of opiates in obstetrical analgesia is a highly specialized field requiring considerable experience and sound judgment to ensure safety. Morphine has been combined with scopolamine in twilight sleep, but this mixture is not used nearly as much as formerly. Various combinations of meperidine, barbiturate, scopolamine, paraldehyde, and the inhalation anesthetics have made morphine less popular in obstetrical work. The opiates are powerful respiratory depressants. The fetus is especially susceptible to morphine, which greatly increases the incidence of asphyxia in the newborn. Morphine and its derivatives are particularly contraindicated in premature labor because of the untoward effect of such medication on the premature infant. 

Absolute contraindication to meperidine and relative contraindication to other narcotic analgesics because of high incidence of hyperpyrexic coma... 

Meperidine (Demerol)—contraindicated with MAOIs Severe reactions with symptoms of hypertension, muscular rigidity, coma, death... 

The pattern and overall incidence of untoward effects that follow the use of meperidine are similar to those observed after equianalgesic doses of morphine, except that constipation and urinary retention may be less common. Patients who experience nausea and vomiting with morphine may not do so with meperidine the converse also may be true. As with other opioids, tolerance develops to some of these effects. The contraindications generally are the same as for other opioids. In patients or addicts who are tolerant to the depressant effects of meperidine, large doses repeated at short intervals may produce an excitatory syndrome including hallucinations, tremors, muscle twitches, dilated pupils, hyperactive reflexes, and convulsions. These excitatory symptoms are due to the accumulation of normeperidine, which has a half-life of 15 to 20 hours compared with 3 hours for meperidine. Opioid antagonists... 

Sufentanil is contraindicated in patients with known hypersensitivity to phenylpiperidine opiates including alfentanil, diphenoxylate, fentanyl, or meperidine. 

The most commonly encountered adverse and serious symptoms are hyperpyrexia, respiratory failure, and impaired consciousness (including coma and death). Even so, there are many published cases and studies that have not revealed any interaction between MAOis and meperidine. All in all, combined therapy is relatively contraindicated. The mechanism of the potentially fatal reactions is unknown. 

The UK manufacturer of linezolid (a drug with weak, reversible, non-selective MAOI activity) contraindicates its use with pethidine, unless facilities are available for close observation and monitoring of blood pressure, because of the possibility of serious reactions, as have occurred with classical MAOIs and pethidine, see MAOIs or RIMAs -I- Opioids Pethidine (Meperidine) , p.1140. 

The absolute contraindication to the use of meperidine is a history of a serotonergic crisis in the past and renal failure. 

Relative contraindications to the use of meperidine include other anti-serotonin drugs, renal dysfunction and seizures. 

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